Patients may have been exposed to serious harm “for many years” because of basic errors by family doctors and GP surgery staff, including vaccines not being properly kept and treatment rooms so dirty they were found to contain maggots.
The safety lapses, which occurred at a small minority of surgeries but nevertheless may have affected thousands, were revealed in a report by the new chief inspector of general practice, Professor Steve Field. Some of the worst instances of carelessness had the potential to result in patient deaths, Professor Field said.
Overall, one third of the 910 GP surgeries inspected by Professor Field’s team in recent months failed on at least one of 16 basic safety and quality standards, with infection control, cleanliness and management of medicines among the most common lapses.
Ten practices had “serious failings that could potentially affect thousands of people”. Inspectors encountered vaccines which were out of date by several months, emergency injections that should have been kept in cold storage left at room temperature, and storage fridges that were not monitored, meaning GPs had no way of knowing whether vaccines were effective or not.
In one case at Dale Surgery in Sneinton, Nottinghamshire - described as a “good practice” - inspectors found maggots, insects and rooms that were dirty and full of cobwebs.
While he said that the surgery in question sorted the problem out “straight away”, Prof Field said: “We're talking about the fact we found maggots in a treatment room.
“And when we asked the question - and this is a good practice - the nurse said yes we do seem to have a bit of a problem.
“We’re talking about some surgeries without doors on the consulting rooms,” he said. “Some of the worst of these, frankly, should have been addressed many, many years ago by the local Primary Care Trusts.
“We found a number of practices where fridge temperatures aren’t being monitored. This wasn’t something we expected to find,” he said, adding that patients at surgeries with poor monitoring could be unaware that vaccinations for infections such as meningitis or measles had failed.
“If you think you’re immune and you’re not, you could then pick up the illness, become very, very poorly and die,” he said. “That can affect many hundreds of patients in a single surgery. If you’ve not tracked it for years that is a major problem.”
Problems with medicine management were encountered at the Kingshurst Medical Practice in Birmingham, the Norris Road Surgery in Cheshire and The Wolds Practice in Lincolnshire.
More than one in five of the surgeries inspected raised concerns over cleanliness and infection control and a third had problems with their management of patient records.
At the Norris Road Surgery “confidential records [were] left unattended or not securely stored in a number of areas of the practice” and it was found that the practice had not completed criminal records bureau checks on staff, a CQC inspection report said.
Many of the practices chosen for early inspection were selected based on previous concerns, so the findings are not necessarily reflective of general practice as a whole.
The CQC said that Kinghurst Practice has since volunteered to deregister and is now being run by a new provider. The CQC will re-inspect the Wolds Practice. A follow-up inspection of the Norris Road Surgery has been carried out but the report has not yet been published. A spokesperson for the surgery said that it had “acted on everything the CQC has asked us to do”.
The inspections, carried out since April 2013, are the first under a new regulatory regime. From April next year the structure of inspections will undergo further reforms. Along with the existing professional inspectors, inspection teams will include a GP, a practice nurse or practice manager, a trainee GP and in some cases a member of the public.
All 8,000 GP practices in the country will be inspected under the new system within two years and in January inspections of GP out-of-hours services will begin.
Professor Field also raised concerns over patient access to GPs, adding that his own father had to wait two weeks for an appointment, and pledged to ensure practices were guaranteeing the provision of services to the most vulnerable groups, including homeless people.
Amid accusations that patients’ difficulty in getting a GP appointment and the poor quality of out-of-hours care in some areas could be driving more people to A&E wards, CQC inspections will also focus on how GP and out-of-hours services work with other urgent care providers in their area.
Professor Field, a Birmingham GP who previously led NHS England’s drive to combat health inequalities, said that his inspection teams had also encountered examples of excellent practice around the country.
“This isn’t about knocking GPs,” he said. “It’s about saying: this is a standard we expect all of you to adhere to.”
Dr Maureen Baker, chair of the Royal College of General Practitioners, said “the vast majority of practices do an excellent job”
“Vaccine storage and cleanliness are two very important priorities for every practice and the low rates of vaccine-preventable disease should reassure patients that there is no widespread breach of 'cold chain' storage for medicines,” she said.
She said that GPs were facing “increasing pressures and unsustainable workloads” adding that family doctors carry out 90 per cent of patient contacts in the NHS, but receive only 8.39 per cent of NHS funding.
The health secretary, Jeremy Hunt said that the new inspection regime would “root out poor standards and celebrate the best”.
Bad practice: CQC’s findings
Norris Road Surgery, Cheshire
“Fourteen boxes of the vaccines for the human papillomavirus vaccine, which prevents infection with certain species of human papillomavirus and some less common cancers, were all out of date by six months.”
Kingshurst Medical Practice, Birmingham
“During our inspection on 13 August 2013 we found further out-of-date medicines… They had an expiry date of 30 June 2013… We also found out-of-date specimen tubes dated 31 January 2013.”